In an episode of “Sex and the City,” Charlotte’s newly-circumcised boyfriend gives the following assessment of the pain of adult circumcision: “On a scale of one to five, I’d give it a 72.”
To get a little more scientific, a 2013 article from the Journal of Urology, titled “How Painful is Adult Circumcision?”, said “Pain is mild to moderate after circumcision … Severe pain is rare and mostly related to complications.”
But even if severe pain is rare, what’s the point of opting to go through any kind of discomfort in one of the most sensitive regions of the body?
Mainly because it could save lives and help end a global health crisis.
In June this year, the UN announced that they intended to end the AIDS epidemic by the year 2030.
One aspect of smashing the disease was accelerating prevention, specifically by aiming to, by the year 2020, “reach 25 million young men in high HIV incidence areas with voluntarily medical male circumcision.”
According to the World Health Organisation (WHO), studies have shown male circumcision can reduce the risk of getting infected by HIV/AIDS in heterosexual men by as much as 60 percent.
Still, the prospect of blades and bleeding from that part of the anatomy makes adult circumcision a hard sell to even the most sensible of men, which is why PrePex has been such a revelation in sub-Saharan Africa.
PrePex
Requiring no injected anesthesia, surgery or stitches, PrePex is a method of voluntary medical male circumcision (VMMC) that can be administered by a nurse in a clean — but not necessarily sterile — environment, in a matter of minutes.
In broad strokes, a nurse — who can be trained to perform the procedure in three days — inserts a rigid ring inside the foreskin at the site of the circumcision, then a rubber ring is released on the exterior of the penis, over the inner ring.
The rings sit in for around seven days, cutting off blood and oxygen flow to the foreskin, during which time the man can go about his daily life as per usual (although the company notes that, “discomfort while wearing the device” can occur).
At the end of the week, a nurse removes the rings and the necrotic foreskin, using a pair of dull scissors.
The removal of the inner ring can involve “brief pain,” although PrePex has testimonials from people who say they felt no pain at all.
Manufactured by Israeli company Circ MedTech Ltd, the whole procedure costs between $15 and $20 and is being offered to adult males in a number of sub-Saharan nations free of charge.
How does circumcision prevent HIV/AIDS?
Associate Professor Andrew Vallely, of the Kirby Institute at University of New South Wales, told News.com.au that while, “there’s no real consensus as to the fundamental mechanism by which male circumcision works,” a workable suggestion as to why the procedure helps prevent infection in heterosexual males has been put forward.
“One of the early hypotheses is that the inner foreskin is fundamentally different to the outer foreskin,” Vallely says.
These differences were thought to be in the inner and outer foreskins’ epithelial structure. The difference makes it easier for HIV/AIDS to infect a man’s body.
“When the penis is erect, during sex, that inner foreskin is exposed and it exposes an area that is more susceptible to HIV infection.”
It’s also important to note that VMMC is not being held up as the key to ending HIV/AIDS, with the WHO saying it, “provides only partial protection,” and that people in high-risk areas should participate in testing and counselling, and practice safe sex by using both male and female condoms.
And while circumcision may help to prevent female-to-male contraction of the virus, according to the United States Centers for Disease Control and Prevention, “Studies of whether circumcision of males reduces HIV transmission to their female sex partners overall indicate no protective effect.”
So should I have my son circumcised or get circumcised myself?
While the WHO has made circumcision a priority in sub-Saharan Africa, it’s a region with high incidence of the auto-immune disease. By comparison, experts have set Australia the ambitious yet achievable target of zero new HIV infections by 2020.
As such, Vallely says Australians don’t really need to consider circumcision for the purpose of HIV/AIDS prevention.
“But circumcision has also been associated with reduced risks of other infections, STIs, and there’s good evidence that circumcision reduces the risk of Human Papilloma Virus,” he says.
“I guess it depends on your rationale, as well as religious and other sociocultural reasons as well.”